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Story Mr. Lungman was already a week in a hospital because of long term respiratory problems. A group of medical students started to examinate him, but they found no pathological finding. But then a student, Miss Diligentous spoke: „Patient has a dry cough, physical examination showed nothing. What about an atypical pneumonia?“ The teacher smiled: Excellent, I am glad that someone found it!

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Atypical pneumoniae The term is now considered obsolete, nevertheless we can use it for pneumoniae that –have a slow oncome, rather non-productive cough, and physical symptomatology is often absent (but x- rays show a visible finding) –are not caused by culturable bacteria (e. g. Streptococcus pneumoniae) –are mostly caused by: respiratory viruses (see further) atypical bacteria, (Mycoplasma pneumoniae, or Chlamydia/Chlamydophila pneumoniae, Legionella sp. In case of bacterial agents, antibiotic therapy (doxycyklin, macrolids) is possible

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The viruses described in this slideshow: respiratory viruses –influenzavirus A and B –parainfluenzavirus –RS viruses –adenoviruses –Mycoplasma pneumoniae – not a virus, but diagnosed using virological methods virus of tick-borne encephalitis

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Influenza (flu) It is a disease of the whole body, but mostly lower respiratory ways. Neither rhinitis, nor sore throat belongs to typical course. Rather dry cough, high fever, myalgia, accute oncome. Sometimes also intestinal problem may occur. Influenza is often dangerous in immunocomprmissed persons (mostly prolonged), pregnant, in elderly. On the orher hand, some subtypes are rather dangerous for young people with very good imunity. This is because of „cytokin storms“ (the problems are related with imunity overreaction) Influenza A, B and C exist; majority of epidemics is caused by virus of influenza A

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Influenzavirus A – antigens Among characteristics of influenzavirus, the most important is antigenic variability. In influenzavirus, we have 15 subtypes according to haemaglutinin antigen (H) and 9 subtypes according to neuraminidase (N). An antigenic drift is a natural mutation in antigenic structure coding genes of a know type of a virus. It does not bring a completely new virus type An antigenic exchange – shift means a reassortment of two or more types of a virus (e. g. avian + human) to a new type. Shift only exists in influenza A, as the other types are purely human Antigenic shift is enabled by segmented genome

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Influenza pandemics As viruses change, sometimes a new variant occurs and nobody is protected against it. Such a virus is then able to produce outbreaks, epidemics or even pandemics in large areas. Of course, it is never possible to predict the course of them. Viruses able to perform an outbreak in human population should have not only elevated virulence, but also the ability to be transmitted person-to-person. Bird viruses rarelly have such ability. Hogs usually serve as „mixing jar“. So virulence factors from birds usually become dangerous after reassortment or recombination with parts of mammal viruses.

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Influenza pandemics 2 During World War One many people died because of so called Spanish influenza During following decades, there were many relatively smaller epidemiae (Hong-Kong flu, Singapore flu) The last epidemics („swine influenza“) was caused by a virus belonging to group A:H1N1. The mere term „A:H1N1“ does not mean anything new, but the detail structure was special, the virus contained parts that are human, avian and swine origin

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Influenza – prevention, prophylaxis, treatment Prevention possible by vaccination, recommended mostly to diseased persons. It protects only agains subtypes actually present in population, not againts new viral subtypes For prophylaxis and treatment, we can use some antivirotics: inhibitors of protein M 2 (amantadin and rimantadin, some strains became resistant already), and inhibitors of neuraminidase (zanamivir and oseltamivir – factory names TAMIFLU and RELENZA). Antivirotics should be used for relevant reasons only. Using them „preventively“ because of panic might lead to development to resistance.

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Parainfluenzaviruses They are paramyxoviruses, related with mumps virus and less related with measles Unlike the true flu they often cause cathars of upper respiratory ways. Nevertheless, flu-like cough may be too, but mustly (especially in adults) without fever. Diagnostics: CFT, HIT, ELISA; there are some cross-reactions. A direct diagnostics in nasopharynx using isolation on cell cultures possible, too.

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RS virus (respiratory syncytia virus, pneumovirus) Related (not very closely) to parainfluenza RS-virus is an important pathogen of lower respiratory ways in first halfth of year As the name says, they cause confluence of infected cells (syncytia) Diagnostics – ELISA, direct dg. – cell cultures Metapneumovirus is a newer virus related to pneumovirus

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Adenoviruses – Uncoated DNA viruses First isolated 1953 from an adenoid vegetation They are human, animal and bird viruses They are medium sized (80 nm), uncoated, with cubic symetry of capsid. They have shape of a perfectly regular icosaedre. The capsid is composed of 240 hexons a 12 top pentons. We know 47 serotypes of adenoviruses, that can be pathogenous for humans. They could differ in symptomas and diagnostic.

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Human adenoviruses They may cause common cold, pharyngitis, conjunctivitis (light to serious) Types 40 and 41 (different also by being unculturable) cause diarrhoea in babies One type may cause inflamation of urinary bladder with bleeding Diagnostics is culture (cell cultures) and serological (complementfixing test) Target therapy is impossible

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Mycoplasmas strange group of bacteria – Mollicutes – „the ones with soft skin" they have no cell wall their shape might be oval, round or filamentous in humans, genera Mycoplasma and Ureaplasma are important smallest organisms with no need for an alien cells several times smaller than common bacteria

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Mycoplasma pneumoniae causative agent of atypical pneumoniae sometimes extrapulmonar complications (hearth, nerves etc.) on the other hand, often only common- cold-like or asymptomatical transmission by air

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Mycoplasma hominis, Ureaplasma urealyticum important agents of sexually transmitted diseases inflammation of vagina and urethra on the other hand, often present in urethra of healthy persons Other urogenital mycoplasmas: Mycoplasma genitalium also sexual organs, unclear importance Mycoplasma penetrans as an opportune infection in AIDS patients

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Mycoplasma: diagnostics and treatment Culture on acelullar, nevertheless special media CFT, ELISA etc. Usually together with serology of respiratory viruses Not possible to use antibiotics acting against the cell wall Effective tetracyclins; in children macrolides (i. e. erythromycin etc.) In M. pneumoniae vaccination attempts – in stage of experiment

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Among viral properties We know already, that viruses are acelullar particles, containing DNA or RNA in a nukleocapsid, and eventually also containing viral envelope A RBC-agglutinating agent may take part in this envelope. This effect was already seen in J08 practical in haemaglutination inhibition test. Simillar is also ability of haemadsorption Other properties: Virus needs alien cells. Such cells are found e. g. in a cell culture or in structures of fertilized egg with a chicken embryo

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Microscopy in virology Electronoptic microscopy is suitable for observation of majority of viruses, but it is very expensive and not available enough (= not in routine diagnostics) Optical microscopy may be used –To observe cytopathic effects in vitro (various viruses) –To observe cellullar inclusions in vivo (Negri bodies in rabies/lyssa) – rather in histology than microbiology –To observe large viruses (poxviruses) – exceptionally, not for routine diagnostics

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Viral isolation Animal now less commonly. Typical animal is a suckling baby mouse. Fertilized egg is a classical method: –Amniotic sac –Allantoic sac –Yolk sac –Chorioallantoic membrane (only here sometimes a visible result – so called pocks; in other cases, the result of egg isolation is not visible) Cell cultures (cultures of „immortal“ human or animal cells – embryonic or tumor cells): –Examples: LEP, HeLa, monkey kindney and various other. Some viruses (only some!) perform a cytopathic effect (CPE) on cell cultures, but some viruses do not.

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Isolation of viruses etc. on an egg Amniotic sac, surrounding the embryo, is used often, e. g. in influenza diagnostics Allantois, used by embyo as cavity for waste, is especially in older embryos easilly accessible. It is not very rich in nutrients Yolk sac is used for chlamydial diagnostics (they are bacteria, but simillar to viruses in properties) Chorioallantoic membrane serves to culture mostly poxviruses and herpesviruses At production of a vaccine, the virus is cultured on allantois (only possible after several passages in amniotic fluid)

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Practical viral agglutination on fertilized egg Ovoscope In time of technically fantastic machines, understandable for less and less technicians, a nice classical aparatus is ovoscope. It consists of a wooden bottle, a bulb and a shiftable wood with two holes. One is round to place an egg standing The second is oval to place an egg laying

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Virus application to amniotic sac: how to do it Use ovoscope to see the air membrane Cut the shell next to air membrane Apply alcohol to paper membrane Use your ovoscop again Using needle, try to „stick the eye of the embryo“ (it runs away anyway) Apply the virus inside Recap the egg and incubate for several weeks

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How can I be sure that a virus is present? Bacteria at culture form visible colonies, or at least they make the broth turbid. On the other hand, in viral isolation the result is visible only sometimes (CPE, pocks), commonly the result is not visible Detection of an isolated viruses should be performed In viruses from amniotic fluid, mostly Hirst test is performed – detection of viral ability to agglutinate erythrocytes In viruses from cell cultures (e. g. virus of influenza from monkey kindey cells), we use rather test of viral haemadsorption

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Cytopathic effect (CPE) on cell cultures Only rarely a cytopathic effect of a virus to a cell makes a change of metabolism, that could be observed as a macroscopically visible colour change after addition of an indicator (as we would see in the virus neutralisation test) More commonly, CPE can be seen in a microscope: –the cells become round –desmosomic inter-cell connections are lost –the cells lose their one-direction orientation –globally, chaos replaces the order Many viruses do not produce any cytopathic effect at all

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www.herpesdiagnosis.com/diagnose.htmlhttp://cmir.mgh.harvard.edu/cellbio/cellculture.php? menuID_=122 (HSV is Herpes Simplex virus – HSV 1 causing mostly herpes labialis, HSV 2 herpes genitalis) You will see the same picture once again later

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Practical observation of cell cultures Put the entire test tubes to a microscope, trying to focus the inner surface. Maybe you will see cell cultures, some of them maybe even with a cytopathic effect An experienced eye recognizes various types of cell cultures, but also various types of eventual cytopathic effects

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Shell-vials techniques Those are techniques of quick culture Inoculum is centrifuged inside of a cell culture growing on a round coverslip Multiplied virus is detected using immunofluorescence with monoclonal antibodies During 24 h after material admission everything is done (while classical culture durates several weeks)

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CFT in respiratory viruses – example The aim is to found, which of six tested agents is responsible for mometnary respiratory problems of our patient Positive: absence of haemolysis  RBC sedimentation to the bottom of the well Negative: haemolysis („strawbery lemonade“) Titer = highest serum dilution with still positive reaction Fourfold increase/decrease of titer is supposed to be significant for running infection when using pair sera

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HIT – tick borne encefalitis (example) Besides CFT, HIT is another classical method to detection of this virus. Positive: blocation of viral agglutination (= sedimentation of RBCs to the bottom). Negative: RBC agglutination („potato like“ fotmation in the well) Titre = highest serum dilution with still positive reaction Fourfold increase/decrease of titer is supposed to be significant for running infection when using pair sera

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The End http://www.tulane.edu/~dmsander/Bi g_Virology/BVDNAadeno.html

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Check-up questions 1. How electronoptic and optic microscopy can be used in virology? 2. What do mean terms „tissue culture“ and „cytopatic effect“? 3. What sites of inoculation are used in fertilized egg? 4. Why experimental animals are sometimes used in virological diagnostics? 5. What specimens and what methods are used in the virological diagnosis of influenza? 6. What methods for detection of viruses require two specimens and what is the ideal time between taking the first and the second? 7. Shells-vials techniques: what are they based on? 8. What are the typical method used for indirect diagnostics of viruses? 9. What type of organism is Mycoplasma pneumoniae? 10. What does the abbreviation „RS virus“ mean?

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